If there's one aspect of 2014 that I enjoyed, it's that it was a very bad year for our old friend, America's quack, a.k.a. Dr. Mehmet Oz. It seemed that, finally, some of the chickens were coming home to roost and Dr. Oz was starting to suffer a bit for his promotion of quackery and pseudoscience on his daytime medical talkshow. The most delicious height of schadenfreude (for skeptics, at least) came mid-year, when Dr. Oz was asked to testify in front of Missouri Senator Claire McCaskill's Senate Committee on Commerce, Science, and Transportation’s Subcommittee on Consumer Protection, which she chairs. What happened next was epic. Dr. Oz was harshly questioned and publicly berated for his irresponsible hawking of unproven, unapproved dietary supplements on his show, and every one of his excuses had been prepared for. In the wake of Oz's humiliation, let's just say that his defenders didn't exactly help the situation.

So here it is, seven months later, and there's an update. Although it's not necessarily more humiliation for Dr. Oz (I'm becoming convinced that the man's ego is beyond humiliation), it is yet another reminder of how irresponsible he has been, in this case, in his discussions and reporting about green coffee bean extract. I've noted before how ridiculous it was of Dr. Oz to portray himself as ill-used when all sorts of manufacturers and sellers of green coffee bean extract started mentioning in their advertising that the extract had been featured on The Dr. Oz Show. Yes, I understand that such advertisements could give the impression that Dr. Oz recommends specific green coffee bean products, although the legal departments of those companies usually made sure that the wording was such that no direct claim that Dr. Oz was endorsing the specific product being sold was being made. On the other hand, it was (and is) truthful to state that Dr. Oz recommended green coffee bean extracts as a weight loss aid because, well, he did, not once but several times. He even ran a pseudo-"clinical trial" to prove that green coffee bean extract worked as a weight loss aid. It was unethical and unscientific.

A daytime talk show guest has agreed to pay $9 million to customers he duped on The Dr. Oz Show and The View.

The Federal Trade Commission accused Lindsey Duncan of selling phony weight-loss aids, including green coffee bean extract, that he claimed could cause consumers to lose 17 pounds and 16 percent of their body fat in 12 weeks – without diet or exercise.

Duncan told Dr. Oz Show viewers that his claims were backed by a clinical study, but the company that sponsored the study settled FTC charges in September that found it to be severely flawed.

Interestingly, for all the times I have blogged about Dr. Oz and his promotion of green coffee bean extract, I don't recall ever having mentioned Duncan before. I'm not sure why, but a search of both this and my not-so-super-secret other blog failed to turn up his name. In any case, here is the FTC's press release from a couple of days ago announcing the settlement:

According to the FTC’s complaint, shortly after Duncan agreed to appear on Dr. Oz but before the show aired, he began selling the extract and tailored a marketing campaign around his appearance on the show to capitalize on the “Oz effect” – a phenomenon in which discussion of a product on the program causes an increase in consumer demand.

For example, while discussing green coffee bean extract during the taping of Dr. Oz, Duncan urged viewers to search for the product online using phrases his companies would use in search advertising to drive consumers to their websites selling the extract. He reached out to retailers, describing his upcoming appearance on The Dr. Oz Show and saying he planned to discuss the clinical trials that purportedly proved the supplement’s effectiveness. He and his companies also began an intensive effort to make the extract available in Walmart stores and on Amazon.com when the program aired.

The defendants continued to use Duncan’s Dr. Oz appearance in their marketing campaign after the show aired, the complaint states, posting links to the episode on websites and using retail point-of-sale displays showing messages such as “New Health Discovery! As Seen on TV, ‘The Dieter’s Secret Weapon.’” After appearing on Dr. Oz, Duncan and his companies sold tens of millions of dollars’ worth of the extract, according to the FTC.

As I was doing searches, I came across this statement from 2012 demonstrating exactly what the FTC is saying in its press release, namely capitalizing on his then-recent appearance on The Dr. Oz Show. Hilariously, in the statement he warns readers against "scam websites" and impure products, urging readers to choose only pure extracts (from websites controlled by him, of course). He even had the chutzpah to warn readers to "be very weary of websites with fake testimonials from paid product reviewers who have never used the product."

Which is exactly the same thing he did, or, as the FTC put it, "Duncan and several of the companies’ paid spokespeople portrayed themselves on television shows as independent sources of information about green coffee bean extract and other natural remedies, while failing to disclose their financial ties to the companies." Projection, thy name is Lindsey Duncan.

It goes way beyond green coffee bean extract, though. It's worthwhile to read through the whole FTC complaint and some of its exhibits. Apparently Duncan appeared on Dr. Oz's show a number of times during 2011 and 2012 to hawk all manner of supplements including green coffee bean extract. Other supplements promoted included various "cancer-fighting" supplements, such as black raspberry. The details of Duncan's machinations are depressing to behold, how in anticipation of an appearance on The Dr. Oz Show, he formed a new company (Pure Health) and website (pureblackraspberry.com) to hawk black raspberry supplements, while choosing search engine terms that he was careful to use during his appearance as examples of what to search for.

Particularly hilarious (and disturbing) is some of the insight the FTC complaint provides into how Dr. Oz's producers operate. For example in April 2012 these producers reached out to Duncan to ask him if he'd be willing to come on the show to discuss green coffee bean extract, and...never mind. I'll go straight to the source and quote the FTC complaint:

20. A producer with “The Dr. Oz Show” first contacted Duncan about appearing as a guest to discuss GCBE in the morning of April 5, 2012. A Dr. Oz Show producer wrote: “We are working on a segment about the weight loss benefits of green coffee bean and I was hoping that Lindsey Duncan might be available to be our expert. Has he studied green coffee bean at all? Would he be able to talk about how it works?” At that time, Duncan had no familiarity with the purported weight-loss benefits of GCBE, nor did Defendants sell GCBE. Nevertheless, within a few hours, a senior member of the Defendants’ public relations team replied: “Awesome! Thanks for reaching out, Dr. Lindsey does have knowledge of the Green Coffee Bean. He loves it!” Later that day, Defendants contacted a manufacturer of GCBE and, on or about the same day, submitted a wholesale order for GCBE raw material.

21. In the evening of April 5, 2012, a producer for “The Dr. Oz Show” emailed Defendants a “very rough outline of the script” for the segment on GCBE shortly after a call between the producer and Duncan. The email stated that the script contained “some sample questions and [the producer’s] sample answers” based on the producer and Duncan’s phone conversation. The draft also contained an introductory segment for Dr. Oz stating that “You may think magic is make believe – but this bean (hold coffee bean) has scientists saying . . . they found the magic weight loss cure for every body type. As a supplement, this miracle pill can burn fat fast! It’s green coffee beans. For those with fat all over and anyone who wants to lose weight – this is very exciting – breaking news!” Defendants edited the script by, among other things, adding language in which Duncan would advise viewers that they could find green coffee bean capsules online by typing the words “Pure Green Coffee Bean Capsules” into their web browsers. The Defendants also added language in which Duncan would advise viewers to “take two 400 mg vegetarian capsules.” Duncan rehearsed his delivery of the script during the days prior to taping the GCBE segment.

So, basically, the producers of The Dr. Oz just assumed that because Duncan had been on the show before he must know about green coffee bean extract. Then:

20. The staff of “The Dr. Oz Show” informed Defendants on April 11, 2012 that the GCBE episode would air on April 26, 2012. On April 11, 2012, a Dr. Oz Show producer also asked Duncan if there was a GCBE brand or site that Duncan recommended. Duncan delayed answering the question until the following day. During that intervening day, he emailed Defendants’ employees: “This is either a set up or manna from the heavens . . . Please get Green Coffee Bean up on our site immediately!!! I will then recco the PH site!!!!! Let me know when it’s up!” Defendants began offering Pure Health brand GCBE capsules for sale online on April 11, 2012. The next day, Duncan replied to the Dr. Oz Show producer that he “did some research” and found that “[w]hen you type ‘green coffee beans’ into your web browser . . . . [t]he one Company that pops up selling a pill or supplement is www.purehealth100.com. They are in the pure coffee category because they are 100% pure. This looks like the best and most authentic product that I could find. The price is fair and they had zero additives.” Duncan did not disclose to the Dr. Oz Show producer his relationship to Pure Health. Over the ensuing months, Defendants continued to attempt to hide Duncan’s relationship to Pure Health from the Dr. Oz Show and the public.

And here is Duncan's appearance on the show:

So what we have here is a story showing the producers of The Dr. Oz Show either to be gullible and incompetent to the point of not even asking if Duncan had a financial relationship to the products he was recommending on his show or to have been complicit, with wink-wink, nudge-nudge plausible deniability. In other words, the producers were either easily duped because they didn't bother to do even minimal research, or they had an inkling that Duncan must be selling what he's promoting but took a "don't ask, don't tell" attitude toward it. To be honest, I rather suspect the latter, although it wouldn't surprise me if it were the former. Whatever the explanation, it just reinforces the utter disingenuousness and utter contempt for their viewers regularly demonstrated by the producers of The Dr. Oz Show, as evidenced by the topics they air. It's hard not to conclude that Dr. Oz himself must share in that contempt. Either that, or he's the amiable empty scrubs who just shows up and reads whatever lines are given him on the cue cards.

Last year, I mocked Dr. Oz for a segment he did on his show in which he headed off to San Diego to "bust" supplement marketers using his name to sell supplements without permission. In reality, it would appear that Dr. Oz's producers either willingly offer up appearances on the show and/lor turn a blind eye to the financial interests of its guests, thus in essence becoming a marketing arm of the supplement industry. In reality, the producers of Dr. Oz's show should be on the hook as well to help pay back those duped by scam artists like Lindsey Duncan, but that will never happen.

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Or: "hypotheses on the ‘how’ and ‘why’ of the supplement shill game"
....
Excellent post! Orac does due journalistic diligence by sticking mainly to the facts, and offering speculation on motives etc. in either/or form that give the players proper benefit of the doubt, especially apt here because as a physician, Orac has limited knowledge of how the sausage of a TV talk show actually gets ground and stuffed into its casing.

However, as I’m in the ‘educated guess’ business and have a more ‘insider’ take on TV sausage-making, I’ll offer some even more critical hypotheses. Beyond that, and i hope more importantly, I’ll then follow these to some broader thoughts on the wider appeal of medi-woo in general. As the 'why' of the wider appeal especially calls for a fairly wordy development, I'm just posting condensed versions of the main 'how' sections below, with the full text on my new page.

OZ HIMSELF:
Amiable empty scrubs who just shows up and reads whatever lines are given him on the cue cards, thus showing utter contempt for the Hippocratic Oath he took as an MD. Probably minimally involved in creation of any individual segment of his show. That's what the producers get paid for — spending time on stuff so Oz doesn't have to. Mehmet Oz is likely only minimally and passively involved in the construction of "Dr. Oz." This is actually more disturbing than it would be if he was running the show and guiding it toward stuff he personally believed in, rather than just showing up and asking, 'OK, what do we beard for today? Is the script in the teleprompter?'

"THE DR OZ SHOW" PRODUCERS
Undoubtedly complicit, with wink-wink, nudge-nudge plausible deniability. They have risen to a high level in an ultra-competitive dog-eat-dog business. There are at least 10 lower-level producers within shouting distance angling to move up the ladder, and if any production staff member at any level were actually gullible or incompetent in any way related to the show, the pack one rung down bring out their inner piranhas, and that's that. The producers don't just have an inkling guests are selling what they're promoting; they know guests are selling something. It's not so much “don’t ask, don’t tell” as just such an obvious condition it doesn't need to be discussed.

The quid pro quo isn't any kind of kickback, but pitch time traded for ratings. The producers know:
1) Telegenic guests will be far more likely to come on the show if they have something to sell. Well, that's probably an understatement. It's more like telegenic guests only come on the show when they have something to sell.
2) Having something to sell gives the guests the motivation to be engaged and entertaining on air, making them good guests.
Thus, the first question any booker for a talk show asks in seeking guests for upcoming segments is 'who has something to sell?' When do A-list guests show up on The Late Show, or The Tonight Show? When they have new movies, or albums, or tours to plug.

THE RECRUITMENT OF LINDSAY DUNCAN
Given the travails of Dr. Phil and others in the TV supplement feature thing, there does seem to be more nudge-nudge-wink-wink here than would be involved in booking guests on other shows and/or for other topics.
"I was hoping that Lindsey Duncan might be available to be our expert. Has he studied green coffee bean at all?"
Translation: Lindsey's been a great guest before. The audience loves him and he pulls good numbers. Does he sell green coffee bean?
"Is there a GCBE brand or site that Lindsey recommends?"
Translation: Just making sure Lindsey knows he'll get a chance to plug his product and site by name on the show
To get a bit farther out into not-implausible speculative possibilities, the producers could have done enough research into GCBE to know:
1) None of the folks currently involved in making GCBE would make good guests on the show, or were at least risky unknowns.
2) Duncan was not currently involved in making GCBE, but his company could gear up for it quickly.
Thus, PERHAPS "I was hoping that Lindsey Duncan might be available to be our expert. Has he studied green coffee bean at all? Is there a GCBE brand or site that Lindsey recommends?"
Translates as: If you guys want to start making GCBE, we'll give you the primo slot as the go-to GCBE pluggers on "The Dr. Oz Show" because we think Lindsey is such an awesome guest.

Duncan said, “This is either a set up or manna from the heavens." If he didn't understand TV at all, he'd have just said 'manna from the heavens' and not even considered the Oz show was offering him a set-up. He might not have been sure, but he might have read the signs well enough to have a pretty good idea it was a set-up, and just felt it too openly gauche to phrase it that way.

But, but, but from what some of the "alt med" media here in UK-ia say this can't be right, because it is only Big Pharma and us shills who make money and all the supplement bods are pure and altruistic and never take a penny...

#4
[Some errors due to averaging of course.]
They lost 17#, over 10% of body weight. So they weighed less than 170#; not horribly overweight (especially if 50:50 male:female group). The amount of fat they started with (16% lost) would be ~0 to 106#. So they are losing some lean as well as 106 would be 62.5% body fat.

You are absolutely correct. Supplement salesmen and alt med entrepreneurs are entirely altruistic humanitarians who merely live in sprawling manors and park-like estates.

The internet will reveal how many of the folk Orac writes about manage to remain humble and down-to-earth despite living in opulence.( e.g. Dr Oz, Dr B, Dr Mercola, Null, Wakefield- all easy to view) . I suspect that these palaces were gifts from admirers or suchlike and that these gentlemen allow poor people to camp in their parlours and use their pools because of their charitable natures.

Bizarrely, the Wall St. Journal has an editorial today lambasting the FTC (and by extension, the Obama Administration) for going after Duncan for what is calls "speech crime".

"The commission ruled 3-2 that Mr. Duncan’s comments were fraudulent advertising and settled with Genesis Today for $9 million in consumer redress.

This is a cramped and legally dubious reading of the First Amendment. Unlike an infomercial, which is paid advertising with a specific product pitch, Mr. Duncan was a TV guest. Dr. Oz retained editorial control and Mr. Duncan was neither paid nor mentioned any product. He has appeared on Dr. Oz’s show on other occasions to discuss products in which he had no financial stake."

So according to the WSJ it is perfectly alright to make bogus weight loss claims for a product in a setting designed to drive sales, and not to reveal to the audience that you have a direct financial stake in the product.

The Journal, incredibly, is trying to point the finger at Democrats for picking on poor Dr. Oz (citing the McCaskill hearing). Now there's a talking point about which all Republicans can be proud - Democratic meanies are cracking down on consumer fraud, vote Republican to stop this "free speech" intrusion.

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